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Clinical Analysis of Severe Acute Pancreatitis: a Report of 88 Cases

Author: YeJiaGai
Tutor: MaTao
School: Shantou University
Course: General Surgery
Keywords: Acute pancreatitis Severe acute pancreatitis Factor analysis Surgical treatment
CLC: R576
Type: Master's thesis
Year: 2011
Downloads: 28
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Abstract


Background and Objective：Severe acute pancreatitis (SAP) occurred in 15%-20% of patients with acute pancreatitis. Itis a serious disease characterized by intra-pancreatic necrosis and associated with single ormultiple organ dysfunction syndromes (MODS). It was generally recognized that surgery canbe considered of major form for infected pancreatic necrosis. However, timing and indication ofSAP have been still controversial. Based on an clinical analysis of the 88 cases of SAP, we willinvestigate the clinical features and summarize treatment experience in order to improve thediagnosis and treatment.Method:14 variables from 88 consecutive patients with SAP admitted to the First AffiliatedHospital of Shantou University Medical College from the past six years were included forstatistical analysis. There variables include age, pathogen, blood amylase, white blood cellcount, serum creatinine, serum calcium, total bilirubin, prothrombin time, packed cell volume,blood sugar, pleural effusion, ascites，whether surgical treatment, surgery option. The mortality,survival rate, complication rate were taken as statistical indicators for staticical analysis tocompare the clinical effectiveness of various factors on acute obstructive.Results:(1)The biliary tract disease, alcohol and hyperlipidemia are the most cause of SAP. Nosignificant difference was noted in mortality between groups with different pathogen(P＞0.05).(2)The differences of serum creatinine，serum calcium，blood sugar and packed cell volume between the survival group and the death group were significant(P<0.05).Insignificantdifference were noted in age，blood amylase，white blood cell count，total bilirubin andprothrombin time between the survival group and the death group(P＞0.05).(3) Insignificant difference were noted in complication rates and mortality between pleuraleffusion positive group and negative group(P＞0.05); Significant difference were noted incomplication rates and mortality between peritoneal effusion positive group and negative group(P<0.05).(4) Significant difference were noted in complication rates between the surgery group andnon-surgery group(P<0.05); Insignificant difference were noted in mortality between thesurgery group and non-surgery group(P＞0.05); Insignificant difference were noted incomplication rates and mortality between emergency and delayed surgical group(P＞0.05).ConclusionsConclusions:(1) The biliary tract disease is the most cause of SAP. Curing the biliary tract disease canlower SAP complication rate effectively.The pathogen was irrelevant with the severity of SAP(2)Early serum creatinine，serum calcium，blood sugar and packed cell volume wereirrelevant with the severity of SAP; and age, blood amylase, white blood cell count, totalbilirubin and prothrombin time were not.(3)The SAP patient with peritoneal effusion or pleural effusion is very high.The patientwith peritoneal effusion was relevant with the complication rates and mortality of SAP; and thepatient with pleural effusion was irrelevant with the complication rates and mortality of SAP;(4)The SAP shoulded adopt the non-surgical operation treatment as far as possible in earlydays, avoiding the emergency operation treatment, the emergency operational indications:①Diagnosis is not clear.②The non-surgical treatment is not working,and it may be infect withpancreas necrosis.③Biliary pancreatitis with biliary obstruction or acute cholangitis.(5) The delayed operational indications:①The non-surgical treatment is not working,andit may be infect with pancreas necrosis.②pancreatic abscess.③pancreatic false cyst.④acutenecrotizing pancreatitis with bleeding greatly.⑤The stomach or bowel necrosis.⑥intestinalfistula or stomach fistula can’t be close.⑦Pathogen treatment of biliary pancreatitis.

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CLC: > Medicine, health > Internal Medicine > Digestive and abdominal diseases > Pancreatic diseases
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